What Does Anxiety Look Like in Children?

Over the last 25 years of private practice, I have seen the rates of anxiety grow exponentially for children and adolescents. There are many reasons for this increase in rates, which include the rise in environmental stressors, daily exposure to news and events through social media, and a deterioration in the sense of community and basic safety.

What many of us forget is that children don’t often know how to express their feelings of worry and anxiety with their words. Instead, they act them out in behaviors that are disruptive at home and at school. It’s important to understand the reasons for these behaviors before we can create a plan to treat them.

According to the DSM-V, anxiety disorders include separation anxiety, selective mutism, specific phobia, social anxiety disorder, panic disorder, generalized anxiety disorder, agoraphobia, and substance/medication-induced anxiety disorder. The most common anxiety disorders in children and adolescents are generalized anxiety disorder, separation anxiety disorder, and social phobia. Obsessive-compulsive disorder is not categorized as an anxiety disorder, but there is a very high correlation between anxiety disorders and obsessive-compulsive behaviors, traits, or disorders. Your child may present with fears, worries, and stresses without meeting the clinical criteria for an anxiety disorder. All children and teens cycle through fears and worries.

When should you be concerned enough to take your child in to see a mental health provider?

Here are a few signs that, taken together, may indicate a need for extra help:

• Crying more days than not

• Difficulties sleeping

• Repeating questions for reassurance even after you’ve answered and reassured your child

• School refusal without a medical reason

• Complaints of stomach aches, headaches, or other somatic issues when no medical issue is present

• Problems with concentration

• Quick to anger or easily irritable.An inability to cope with unexpected changes.

• Reports of constant worries or negative thoughts

• Anticipating problems in new situations

• Being clingy with parents or caregivers

• Worries about caregivers’ safety when away from them

• Being tense or fidgety

• Struggles with toileting (either constipation or diarrhea)

• Poor appetite

In my private practice, I’ve discovered two distinct personality or temperament types that I see in children who have anxiety disorders. These two styles both express an underlying anxiety disorder but show up in very different ways. I’ve found that talking with parents about how their child’s unique personality impacts how they display anxious symptoms can be very helpful.

Instead of interpreting their child’s behaviors as hyperactivity or defiance, they might understand that what drives the behavior is their child’s need to release anxiety.

1. Shy and insecure

• internalize their feelings, and typically who won’t assert oneself.

• conflict avoidant

• self-blaming

• constantly working on how they can adapt to the environment

• more prone to depression

• internally rigid, but externally will go with what others want

• display somatic excuses for attending events that they said yes to when they really meant “no”

• intense fear of disappointing others or of socially uncomfortable moments

• tends to be highly sensitive and perceptive of others’ feelings.

• isn’t sure who he/she is due to a lifetime of behaving like a chameleon.

2. Confident and filled with an inner tension that is put out on other people.

• appears to have ADHD or too much energy when it is actually nervous energy

• talks too much because of nervousness

• tends to be more irritable and “moody”

• shows lower insight about the reason for irritability.

• blames others for “stressing them out”

• demands that the situational stress be reduced in order to cope

• rigid but without the insight that it is coming from them

• believes he/she is “right” and can get locked into the intellectual argument

If you see your child falling into either of these two styles, keep your eyes open for the situations that might create anxiety in your child. Instead of being focused on helping your child stop disruptive or worrying behavior, help him figure out what is causing the anxiety. Be a detective with your child, and you’ll find that she will feel validated and more likely to go to you with her words rather than acting out in her behavior.